1
|
Poonia K, Thami GP, Dogar K, Jain S. Clinico-Laboratory Profile of Tuberculides: An Experience at a Tertiary Care Centre from Chandigarh, India. Indian J Dermatol 2024; 69:201. [PMID: 38841219 PMCID: PMC11149802 DOI: 10.4103/ijd.ijd_1191_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Background Tuberculides are characterised by delayed-type of immunologic reactions to Mycobacterium tuberculosis or its products in immuno-competent individuals. We herein describe clinico-epidemiological features and response to treatment in patients with tuberculides from a tertiary care centre from North India. Methods This was a retrospective analysis of the clinical records of all the cutaneous tuberculosis (TB) patients (year 2000-2019) enrolled in the TB clinic. The patient records fulfilling the diagnostic criteria of tuberculides were considered for analysis. Results A total of 225 patients attended the tuberculosis clinic; out of this, 34 were diagnosed as tuberculides. Out of these 34 cases, 21 were identified as LS, 2 erythema induratum of Bazin, 1 papulonecrotic tuberculide, and 10 erythema nodosum. History of contact to open cases of TB was present in 15/34 (44.1%) patients. History of BCG vaccination was found in 15/34 (44.1%) patients. The focus of underlying TB could be identified in 20/34 (58.8%) patients. Skin biopsy was performed in all patients. In all patients, the diagnosis was confirmed by clinico-pathological correlation, positive TST, and the underlying focus of TB. All patients received 6 months regimen of anti-tubercular therapy with first-line drugs. Conclusion In this study, we demonstrated various forms of tuberculides; lichen scrofulosorum was the most common form. We also included erythema nodosum cases also, which responded well to ATT. Observation from our study showed that tuberculides are important cutaneous markers for underlying tuberculosis infection, which helps in early detection of occult tuberculosis and timely management.
Collapse
Affiliation(s)
- Kavita Poonia
- From the Department of Dermatology, Venereology and Leprology, Government Medical College and Hospital, Chandigarh, Punjab, India
- Department of Dermatology, Venereology and Leprology, All Indian Institute of Medical Sciences, Bathinda, Punjab, India
| | - Gurvinder Pal Thami
- From the Department of Dermatology, Venereology and Leprology, Government Medical College and Hospital, Chandigarh, Punjab, India
| | - Kanika Dogar
- From the Department of Dermatology, Venereology and Leprology, Government Medical College and Hospital, Chandigarh, Punjab, India
| | - Surbhi Jain
- From the Department of Dermatology, Venereology and Leprology, Government Medical College and Hospital, Chandigarh, Punjab, India
| |
Collapse
|
2
|
Wu CH, Chen CW. Seventy-five-year-old woman with month-long fever, cavity lung lesions and cutaneous ulcer. Emerg Med J 2024; 41:150-198. [PMID: 38378232 DOI: 10.1136/emermed-2023-213194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 02/22/2024]
Affiliation(s)
- Chang-Han Wu
- Emergency Department, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan
- Emergency Department, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Wei Chen
- Emergency Department, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan
- Emergency Department, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
3
|
Yadav S. Multiple Tubercular Cervical, Supraclavicular, and Pretracheal Lymphadenitis With Scrofuloderma: A Rare Case. Cureus 2023; 15:e51134. [PMID: 38283508 PMCID: PMC10811415 DOI: 10.7759/cureus.51134] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/30/2024] Open
Abstract
In clinical settings, cutaneous tuberculosis is an uncommon occurrence. On the other hand, incidences of this kind of tuberculosis are usually documented in high-burden nations. Despite being the most prevalent variety of cutaneous tuberculosis, scrofuloderma frequently goes undiagnosed. The present case is a rare case of simultaneous involvement of cervical, supraclavicular, and pretracheal lymph nodes and skin due to Mycobacterium tuberculosis. A 26-year-old Indian female was diagnosed after a careful diagnostic workup involving fine needle aspiration cytology, a cartridge-based nucleic acid amplification test, and a biopsy. The case is remarkable as there was no pulmonary involvement. She was initiated on antitubercular treatment per national policy.
Collapse
Affiliation(s)
- Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
| |
Collapse
|
4
|
Zhang X, Liu J. A Case of Tuberculosis Cutis Orificialis. Clin Cosmet Investig Dermatol 2023; 16:2659-2661. [PMID: 37780690 PMCID: PMC10540695 DOI: 10.2147/ccid.s428884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
This work reports a case of a 49-year-old male suffering from chronic tuberculosis who developed painful ulcers around the anus for approximately eight months. The colonoscopy revealed the presence of ulcers in the transverse colon, which were also found in the skin and intestine, as revealed by microscopic examination. The skin ulcer was positive for tuberculosis bacilli, leading to the final diagnosis of Tuberculosis cutis orificialis. The patient had a previous history of tuberculosis, which indicated that the infection in the lungs moved down to invade the intestines and finally the skin.
Collapse
Affiliation(s)
- XiaoYan Zhang
- Department of Dermatology, Hangzhou Third People’s Hospital, Affiliated Hangzhou Dermatology Hospital of Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Jifeng Liu
- Department of Dermatology, Hangzhou Third People’s Hospital, Affiliated Hangzhou Dermatology Hospital of Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| |
Collapse
|
5
|
Brehm TT, Terhalle E. [Extrapulmonary tuberculosis]. Dtsch Med Wochenschr 2023; 148:1242-1249. [PMID: 37793616 DOI: 10.1055/a-1937-8186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Extrapulmonary tuberculosis (TB) presents unique diagnostic and therapeutic challenges. The site of involvement can vary widely, with common sites including the lymph nodes, pleura, skin, ear, nose and throat, genitourinary system, pericardium, gastrointestinal tract, bones and joints, and central nervous system. Clinical manifestations of extrapulmonary TB are diverse and often non-specific. Diagnosis is based on a combination of clinical suspicion, imaging, histopathology, and microbiology. Treatment of extrapulmonary TB generally follows similar principles to pulmonary TB, but the duration of treatment depends on the site of involvement and the extent of the disease. Increased awareness among healthcare providers is essential for the timely recognition and effective management of extrapulmonary TB cases.
Collapse
|
6
|
Nguyen KH, Alcantara CA, Glassman I, May N, Mundra A, Mukundan A, Urness B, Yoon S, Sakaki R, Dayal S, Chowdhury T, Harshavardhan S, Ramanathan V, Venketaraman V. Cutaneous Manifestations of Mycobacterium tuberculosis: A Literature Review. Pathogens 2023; 12:920. [PMID: 37513768 PMCID: PMC10385667 DOI: 10.3390/pathogens12070920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/01/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Tuberculosis is an ancient disease that humanity struggled with for centuries and continues to struggle with. The bacteria Mycobacterium tuberculosis often infects the lungs through respiratory transmission and manifests itself through various symptoms, including cutaneous infections. Cutaneous tuberculosis (CTB) comprises about 1% to 1.5% of all extrapulmonary manifestations and is often accompanied by polymorphous lesions, including papules, nodules, plaques, ulcers, gummas, and verrucous lesions. CTB is most commonly observed in low-income, HIV, and immunosuppressed populations, similar to intrapulmonary manifestations. The main pathogen for CTB is M. tuberculosis but less commonly with M. bovis and BCG vaccine, and the modes of transmission are largely classified into exogenous and endogenous CTB. Current treatment options for CTB include oral therapy of antibiotic medications such as rifampicin, streptomycin, ethambutol, isoniazid, and pyrazinamide, which is occasionally combined with surgical intervention.
Collapse
Affiliation(s)
- Kevin H Nguyen
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Cheldon Ann Alcantara
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Ira Glassman
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Nicole May
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Akaash Mundra
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Abinanda Mukundan
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Bianca Urness
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Sonyeol Yoon
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Roajhaan Sakaki
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Surbi Dayal
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Tanzila Chowdhury
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Shakila Harshavardhan
- Department of Molecular Microbiology, Madurai Kamaraj University, Tamil Nadu 625021, India
| | - Vadakupattu Ramanathan
- Department of Pathology, National Institute for Research in Tuberculosis, Chennai 600031, India
| | - Vishwanath Venketaraman
- Department of Basic Sciences, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| |
Collapse
|
7
|
Mei YM, Zhang WY, Sun JY, Jiang HQ, Shi Y, Xiong JS, Wang L, Chen YQ, Long SY, Pan C, Luo T, Wang HS. Genomic characteristics of Mycobacterium tuberculosis isolates of cutaneous tuberculosis. Front Microbiol 2023; 14:1165916. [PMID: 37266022 PMCID: PMC10230547 DOI: 10.3389/fmicb.2023.1165916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/19/2023] [Indexed: 06/03/2023] Open
Abstract
Objectives Cutaneous tuberculosis with various manifestations can be divided into several clinical types according to the host's immune status and infective route. However, the etiological factors of this disease remain unclear. The objective of this study is to investigate the pathogens associated with the occurrence and different types of cutaneous tuberculosis. Methods 58 Mycobacterium tuberculosis strains isolated from cutaneous tuberculosis over the last 20 years were sequenced and analyzed for genomic characteristics including lineage distribution, drug-resistance mutations, and mutations potentially associated with different sites of infection. Results The M. tuberculosis strains from four major types of cutaneous tuberculosis and pulmonary tuberculosis shared similar genotypes and genomic composition. The strains isolated from cutaneous tuberculosis had a lower rate of drug resistance. Phylogenic analysis showed cutaneous tuberculosis and pulmonary tuberculosis isolates scattered on the three. Several SNPs in metabolism related genes exhibited a strong correlation with different infection sites. Conclusions The different infection sites of TB may barely be affected by large genomic changes in M. tuberculosis isolates, but the significant difference in SNPs of drug resistance gene and metabolism-related genes still deserves more attention.
Collapse
Affiliation(s)
- You-Ming Mei
- Hospital of Skin Disease, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Wen-Yue Zhang
- Hospital of Skin Disease, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Ji-Ya Sun
- Center for Systems Medicine, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Suzhou, China
- Suzhou Institute of Systems Medicine, Suzhou, China
| | - Hai-Qin Jiang
- Hospital of Skin Disease, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Ying Shi
- Hospital of Skin Disease, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Jing-Shu Xiong
- Hospital of Skin Disease, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Le Wang
- Hospital of Skin Disease, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Yan-Qing Chen
- Hospital of Skin Disease, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Si-Yu Long
- Hospital of Skin Disease, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Chun Pan
- Hospital of Skin Disease, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| | - Tao Luo
- Department of Pathogen Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Hong-Sheng Wang
- Hospital of Skin Disease, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Nanjing, China
| |
Collapse
|
8
|
Haque OI, Rizvi SA, Siddiqui Z. Disseminated tuberculosis involving the eye, skin, axillary lymph nodes and lungs in an immunocompetent host. BMJ Case Rep 2023; 16:e254392. [PMID: 37188489 PMCID: PMC10186401 DOI: 10.1136/bcr-2022-254392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
A female in her early 40s presented to the outpatient clinic for weight loss, fatigue, cough, followed by a gradual painful loss of vision in the right eye associated with redness over the past 3 months. Physical examination revealed bilateral axillary lymphadenopathy and non-healing skin ulcers on the left forearm and the left gluteal region. The patient had no light perception in the right eye and grade 4+ cells in the anterior chamber. A chest X-ray showed a cavitary lesion in the left upper lobe. Histopathological tests from the skin and lymph nodes revealed caseating granulomas, raising the suspicion of tuberculosis. A sputum nucleic acid amplification test was performed, which returned positive for Mycobacterium tuberculosis The patient was treated with antitubercular chemotherapy and showed encouraging signs of progress after the treatment.
Collapse
Affiliation(s)
| | - Syed Asghar Rizvi
- Jawaharlal Nehru Medical College and Hospital, Aligarh, Uttar Pradesh, India
| | - Ziya Siddiqui
- Jawaharlal Nehru Medical College and Hospital, Aligarh, Uttar Pradesh, India
| |
Collapse
|
9
|
Garon L, Hill A. A case of scrofuloderma of the axilla presenting as hidradenitis suppurativa: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221117706. [PMID: 36225223 PMCID: PMC9549081 DOI: 10.1177/2050313x221117706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Scrofuloderma is an uncommon cutaneous presentation of tuberculosis. It can be
difficult to diagnose, as it can mimic various skin conditions, including
hidradenitis suppurativa. We report a case of a 46-year-old female refugee
patient with a history of nodules and sinus tracts in the left axilla treated
for many years as hidradenitis suppurativa in her home country who was later
found to have scrofuloderma. The diagnosis was based on a positive
Mycobacterium tuberculosis polymerase chain reaction from
an ultrasound-guided aspiration. Further investigation excluded pulmonary
tuberculosis. In cases with an atypical presentation of hidradenitis
suppurativa, imaging, along with histological and microbiologic examination are
warranted to exclude scrofuloderma.
Collapse
Affiliation(s)
- Laurence Garon
- Laurence Garon, Division of Dermatology,
Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM),
Montréal, QC, Canada H2X 0C1.
| | | |
Collapse
|
10
|
Kong M, Li W, Kong Q, Dong H, Han A, Jiang L. Application of metagenomic next-generation sequencing in cutaneous tuberculosis. Front Cell Infect Microbiol 2022; 12:942073. [PMID: 36211955 PMCID: PMC9539668 DOI: 10.3389/fcimb.2022.942073] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Tuberculous infection in a skin wound is a rare but well-known condition. This study describes a child infected with tuberculosis after being wounded. Because of swelling and pain in his wrist tissue, he was admitted to the Affiliated Hospital of Jining Medical University of Shandong Province on 16 October 2021. His medical history only included a wound. He was discharged after debridement. The laboratory data were normal. Two months after surgery, his wound was still swollen and painful. Secretions from the wound were sent for metagenomic next-generation sequencing (mNGS), which revealed three reads related to the Mycobacterium tuberculosis complex group (MTBC). A diagnosis of cutaneous tuberculosis (TB) was made. The wound disappeared after anti-TB drugs were administered. This case demonstrates that, while TB presenting as a severe cutaneous wound is rare, it should be considered in the clinical diagnosis. Clinicians should also pay attention to extrapulmonary infection with MTBC in patients, particularly in some long-suffering patients, and identify the specific pathogen as soon as possible. mNGS could help to identify pathogens and facilitate early treatment, thereby improving the prognosis.
Collapse
Affiliation(s)
- Min Kong
- Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, China
- Medical Laboratory of Jining Medical University, Jining Medical University, Jining, China
| | - Wei Li
- Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, China
| | - Qingsheng Kong
- Medical Laboratory of Jining Medical University, Jining Medical University, Jining, China
| | - Haixin Dong
- Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, China
| | - Aizhong Han
- Medical Laboratory of Jining Medical University, Jining Medical University, Jining, China
| | - Liqing Jiang
- Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, China
- Medical Laboratory of Jining Medical University, Jining Medical University, Jining, China
- *Correspondence: Liqing Jiang,
| |
Collapse
|
11
|
George S, Muhaj FF, Nguyen CD, Tyring SK. Part I Antimicrobial resistance: Bacterial pathogens of dermatologic significance and implications of rising resistance. J Am Acad Dermatol 2022; 86:1189-1204. [PMID: 35122894 PMCID: PMC8808428 DOI: 10.1016/j.jaad.2021.11.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 12/24/2022]
Abstract
Although the COVID-19 pandemic has been the defining global health crisis of our time, public health officials have been sounding the alarm of another ominous threat for years: an impending antimicrobial resistance crisis. In dermatology, antibiotics are often used for prolonged courses in the treatment of skin and soft tissue infections and common inflammatory skin conditions, increasing the risk of microbiome alteration and antibiotic-related adverse effects, all while exerting consequential selective pressures on both pathogenic and bystander bacteria. In this review, we hope to raise awareness of the crisis of antimicrobial resistance and review resistance concerns related to dermatology-relevant bacterial pathogens.
Collapse
Affiliation(s)
- Saira George
- Department of Dermatology, MD Anderson Cancer Center, Houston, Texas
| | - Fiorinda F Muhaj
- Department of Dermatology, MD Anderson Cancer Center, Houston, Texas; Department of Dermatology, University of Texas McGovern Medical School at Houston, Houston, Texas
| | | | - Stephen K Tyring
- Department of Dermatology, University of Texas McGovern Medical School at Houston, Houston, Texas; Center for Clinical Studies, Houston, Texas.
| |
Collapse
|
12
|
Isoletta E, Ciolfi C, Bonometti A, Sachs M, Brazzelli V. An atypical presentation of tuberculous gumma heralding a diagnosis of lymph node tuberculosis: hindsight is 20/20. JAAD Case Rep 2022; 24:14-17. [PMID: 35542318 PMCID: PMC9079164 DOI: 10.1016/j.jdcr.2022.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
13
|
Amorim JR, Nunes BEBR, Silva FWDSD, Magalhães ACSD, Moreno de Oliveira Fernandes TR, Carmo RF, Souza CDF. Disseminated cutaneous tuberculosis in an immunocompetent patient: a clinical challenge in the public health system in Brazil. Int J Dermatol 2022; 61:771-773. [DOI: 10.1111/ijd.16108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/10/2021] [Accepted: 01/06/2022] [Indexed: 11/26/2022]
Affiliation(s)
- José Roberto Amorim
- Department of Medicine Federal University of Alagoas Arapiraca AL Brazil
- Post‐Graduation Program in Family Health, Department of Medicine Federal University of Alagoas Arapiraca AL Brazil
| | | | | | | | | | - Rodrigo Feliciano Carmo
- College of Pharmaceutical Sciences Federal University of the São Francisco Valley (UNIVASF) Petrolina Pernambuco Brazil
| | - Carlos Dornels Freire Souza
- Department of Medicine Federal University of Alagoas Arapiraca AL Brazil
- Post‐Graduation Program in Family Health, Department of Medicine Federal University of Alagoas Arapiraca AL Brazil
| |
Collapse
|
14
|
Brito ACD, Oliveira CMMD, Unger DAA, Bittencourt MDJS. Cutaneous tuberculosis: epidemiological, clinical, diagnostic and therapeutic update. An Bras Dermatol 2022; 97:129-144. [PMID: 34996655 PMCID: PMC9073256 DOI: 10.1016/j.abd.2021.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 12/23/2022] Open
Abstract
Tuberculosis is certainly one of the diseases considered to be ancient on planet Earth. The etiological agent of tuberculosis is Mycobacterium tuberculosis. This terrible bacterial infection still results in severe socioeconomic consequences to date, and its complete eradication represents a great challenge. It constitutes one of the most important public health problems in developing countries. According to the World Health Organization, this infection results in more than 4,000 deaths daily worldwide, with 10.4 million being affected annually and 1.5 million deaths from TB every year. With the emergence of the HIV/AIDS pandemic, the disease became the main cause of morbidity and mortality in patients infected with the human immunodeficiency virus. Cutaneous tuberculosis is a rare infection that represents 1% to 1.5% of extrapulmonary tuberculosis, whose etiological agents are Mycobacterium tuberculosis, Mycobacterium bovis, and the attenuated form of the bacillus Calmette-Guérin (BCG vaccine). Cutaneous tuberculosis can be exogenous; endogenous: caused by contiguity or autoinoculation and by hematogenous spread; induced by the Calmette-Guérin bacillus and manifest as a tuberculid. The diagnosis of the infection is carried out through the direct test, culture, histopathology, tuberculin skin test, polymerase chain reaction, interferon-gamma release assay, and genotyping. Drugs used comprise isoniazid, rifampicin, pyrazinamide and ethambutol.
Collapse
|
15
|
Aróstegui Aguilar J, Diago A, Carrillo Gijón R, Fernández Figueras M, Fraga J, García Herrera A, Garrido M, Idoate Gastearena M, Christian Laga A, Llamas-Velasco M, Martínez Campayo N, Monteagudo C, Onrubia J, Pérez Muñoz N, Ríos-Martín J, Ríos-Viñuela E, Rodríguez Peralto J, Rozas Muñoz E, Sanmartín O, Santonja C, Santos-Briz A, Saus C, Suárez Peñaranda J, Velasco Benito V, Beato Merino M, Fernandez-Flores A. Granulomas in Dermatopathology: Principal Diagnoses — Part 2. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
16
|
Gao LJ, Huang ZH, Jin QY, Zhang GY, Gao MX, Qian JY, Zhu SX, Yu Y. Delayed diagnosis and comprehensive treatment of cutaneous tuberculosis: A case report. World J Clin Cases 2021; 9:4007-4015. [PMID: 34141760 PMCID: PMC8180233 DOI: 10.12998/wjcc.v9.i16.4007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/07/2021] [Accepted: 03/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) is a widespread infectious disease, with an incidence that is increasing worldwide. Cutaneous TB (CTB) occurs rarely, accounting for less than 1% of all TB cases. Due to the clinical presentation and diagnostic difficulties, CTB is often clinically neglected and misdiagnosed.
CASE SUMMARY A 32-year-old man underwent several debridement surgeries and skin flap transplantation after trauma. The wound remained unhealed, accompanied by sinus formation. According to empirical judgment, T-cell spot of TB test, and bacterial culture of pyogenic fluids, he was diagnosed with CTB due to infection with exogenous Mycobacterium tuberculosis. A comprehensive anti-TB regimen that included isoniazid, rifampicin, ethambutol, and pyrazinamide was applied. The sinus was filled with a hydrophilic fiber-containing silver dressing, and wound-protecting sponges were applied to part of the wound. The wound healed after 40 d. No ulceration was found within 2 mo after discharge; further follow-up will be conducted.
CONCLUSION A non-healing wound may be caused by TB infection. Comprehensive treatment of CTB is effective.
Collapse
Affiliation(s)
- Lu-Jue Gao
- Department of Extrapulmonary Tuberculosis, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing 210014, Jiangsu Province, China
| | - Zi-Hui Huang
- Department of Extrapulmonary Tuberculosis, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing 210014, Jiangsu Province, China
| | - Quan-Yong Jin
- Department of Extrapulmonary Tuberculosis, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing 210014, Jiangsu Province, China
| | - Guo-Ying Zhang
- Department of Laboratory, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing 210014, Jiangsu Province, China
| | - Min-Xing Gao
- Department of Extrapulmonary Tuberculosis, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing 210014, Jiangsu Province, China
| | - Jia-Yan Qian
- Department of Extrapulmonary Tuberculosis, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing 210014, Jiangsu Province, China
| | - Si-Xun Zhu
- Department of Extrapulmonary Tuberculosis, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing 210014, Jiangsu Province, China
| | - Yang Yu
- Department of Extrapulmonary Tuberculosis, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing 210014, Jiangsu Province, China
| |
Collapse
|
17
|
Extrapulmonary Tuberculosis—An Update on the Diagnosis, Treatment and Drug Resistance. JOURNAL OF RESPIRATION 2021. [DOI: 10.3390/jor1020015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pathogenic Mycobacterium tuberculosis complex organisms (MTBC) primarily cause pulmonary tuberculosis (PTB); however, MTBC are also capable of causing disease in extrapulmonary (EP) organs, which pose a significant threat to human health worldwide. Extrapulmonary tuberculosis (EPTB) accounts for about 20–30% of all active TB cases and affects mainly children and adults with compromised immune systems. EPTB can occur through hematogenous, lymphatic, or localized bacillary dissemination from a primary source, such as PTB, and affects the brain, eye, mouth, tongue, lymph nodes of neck, spine, bones, muscles, skin, pleura, pericardium, gastrointestinal, peritoneum, and the genitourinary system as primary and/or disseminated disease. EPTB diagnosis involves clinical, radiological, microbiological, histopathological, biochemical/immunological, and molecular methods. However, only culture and molecular techniques are considered confirmatory to differentiate MTBC from any non-tuberculous mycobacteria (NTM) species. While EPTB due to MTBC responds to first-line anti-TB drugs (ATD), drug susceptibility profiling is an essential criterion for addressing drug-resistant EPTB cases (DR-EPTB). Besides antibiotics, adjuvant therapy with corticosteroids has also been used to treat specific EPTB cases. Occasionally, surgical intervention is recommended, mainly when organ damage is debilitating to the patient. Recent epidemiological studies show a striking increase in DR-EPTB cases ranging from 10–15% across various reports. As a neglected disease, significant developments in rapid and accurate diagnosis and better therapeutic interventions are urgently needed to control the emerging EPTB situation globally. In this review, we discuss the recent advances in the clinical diagnosis, treatment, and drug resistance of EPTB.
Collapse
|
18
|
Silva DR, Rabahi MF, Sant’Anna CC, da Silva-Junior JLR, Capone D, Bombarda S, de Miranda SS, da Rocha JL, Dalcolmo MMP, Rick MF, Santos AP, Dalcin PDTR, Galvão TS, Mello FCDQ. Diagnosis of tuberculosis: a consensus statement from the Brazilian Thoracic Association. J Bras Pneumol 2021; 47:e20210054. [PMID: 34008763 PMCID: PMC8332844 DOI: 10.36416/1806-3756/e20210054] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/11/2021] [Indexed: 12/19/2022] Open
Abstract
Early, accurate diagnosis of tuberculosis is one of the major pillars of the control of the disease. The purpose of this consensus statement is to provide health professionals with the most current, useful evidence for the diagnosis of tuberculosis in Brazil. To that end, the Tuberculosis Committee of the Brazilian Thoracic Association brought together 14 members of the Association with recognized expertise in tuberculosis in Brazil to compose the statement. A nonsystematic review of the following topics was carried out: clinical diagnosis, bacteriological diagnosis, radiological diagnosis, histopathological diagnosis, diagnosis of tuberculosis in children, and diagnosis of latent tuberculosis infection.
Collapse
Affiliation(s)
- Denise Rossato Silva
- . Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | | | - Clemax Couto Sant’Anna
- . Faculdade de Medicina, Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro (RJ) Brasil
| | - José Laerte Rodrigues da Silva-Junior
- . Faculdade de Medicina, Universidade de Rio Verde - UNIRV - Aparecida de Goiânia (GO) Brasil
- . Curso de Medicina, Centro Universitário de Anápolis - UniEVANGÉLICA - Anápolis (GO) Brasil
| | - Domenico Capone
- . Universidade do Estado do Rio de Janeiro - UERJ - Rio de Janeiro (RJ) Brasil
| | - Sidney Bombarda
- . Secretaria de Estado da Saúde de São Paulo, Programa de Controle da Tuberculose, São Paulo (SP) Brasil
| | | | - Jorge Luiz da Rocha
- . Centro de Referência Hélio Fraga, Fundação Oswaldo Cruz - Fiocruz - Rio de Janeiro (RJ) Brasil
| | | | | | - Ana Paula Santos
- . Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro - UERJ - Rio de Janeiro (RJ) Brasil
- . Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro (RJ) Brasil
| | - Paulo de Tarso Roth Dalcin
- . Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
- . Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Porto Alegre (RS) Brasil
| | | | | |
Collapse
|
19
|
Nielens N, Marot L, Baeck M. Sporotrichoid distributed tuberculous panniculitis as a late complication of intravesical Bacillus Calmette-Guérin (BCG) immunotherapy. Int J Infect Dis 2021; 117:247-250. [PMID: 33984512 DOI: 10.1016/j.ijid.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/01/2021] [Accepted: 05/06/2021] [Indexed: 11/29/2022] Open
Abstract
An 82-year-old man presented with unilateral oedema of the right lower limb overlaid with multiple, sporotrichoid distributed, panniculitis lesions. These symptoms appeared in a context of immunodepression and were associated with significant weight loss and deteriorated general condition. Patient's medical history, the histological findings, PCR testing and bacterial culture led to a diagnosis of cutaneous tuberculosis due to Mycobacterium bovis. This infection occurred as a late complication of intravesical Bacillus Calmette-Guérin (BCG) instillations that the patient had received as an adjunctive immunotherapy for bladder cancer. This is an unusual clinical presentation and aetiology of cutaneous tuberculosis. Indeed, the observed sporotrichoid pattern is uncommon for tuberculous mycobacteria. Moreover, the occurrence of tuberculous skin lesions after intravesical BCG instillations is extremely rare, with only a few cases described, and, to our knowledge, none with such clinical presentation. This case report suggests that a medical history of BCG immunotherapy should always be considered when assessing any infectious-type cutaneous lesions and that skin should be regarded as a possible late localization of infectious complications of this treatment.
Collapse
Affiliation(s)
- Nina Nielens
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Liliane Marot
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Marie Baeck
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium.
| |
Collapse
|
20
|
Aróstegui Aguilar J, Diago A, Carrillo Gijón R, Fernández Figueras M, Fraga J, García Herrera A, Garrido M, Idoate Gastearena MA, Christian Laga A, Llamas-Velasco M, Martínez Campayo N, Monteagudo C, Onrubia J, Pérez Muñoz N, Ríos-Martín JJ, Ríos-Viñuela E, Rodríguez Peralto JL, Rozas Muñoz E, Sanmartín O, Santonja C, Santos-Briz A, Saus C, Suárez Peñaranda JM, Velasco Benito V, Beato Merino MJ, Fernandez-Flores A. Granulomas in Dermatopathology: Principal Diagnoses - Part 2. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S0001-7310(21)00138-1. [PMID: 33891884 DOI: 10.1016/j.ad.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022] Open
Abstract
Part 2 of this series on granulomatous diseases focuses on skin biopsy findings. Whereas the first part treated noninfectious conditions (metabolic disorders and tumors, among other conditions), this part mainly deals with various types of infectious disease along with other conditions seen fairly often by clinical dermatologists.
Collapse
Affiliation(s)
- J Aróstegui Aguilar
- Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, España
| | - A Diago
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - R Carrillo Gijón
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - M Fernández Figueras
- Servicio de Anatomía Patológica, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | - J Fraga
- Servicio de Anatomía Patológica, Hospital Universitario de La Princesa, Madrid, España
| | - A García Herrera
- Servicio de Anatomía Patológica, Hospital Clínic, Barcelona, España
| | - M Garrido
- Departamento de Anatomía Patológica, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación I+12, Madrid, España
| | - M A Idoate Gastearena
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena, Departamento de Citología, Histología y Anatomía Patológica, Facultad de Medicina, Universidad de Sevilla, Sevilla, España
| | - A Christian Laga
- Departamento de Patología, Brigham and Women's Hospital, Boston, Massachusetts, Estados Unidos
| | - M Llamas-Velasco
- Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, España
| | - N Martínez Campayo
- Servicio de Dermatología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - C Monteagudo
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valencia, Facultad de Medicina, Universidad de Valencia, Valencia, España
| | - J Onrubia
- Servicio de Anatomía Patológica, Hospital Universitario San Juan de Alicante, Sant Joan d'Alacant, Alicante, España
| | - N Pérez Muñoz
- Servicio de Anatomía Patológica, Hospital Universitari General de Catalunya, Quirón salud, Sant Cugat del Vallès, Barcelona, España
| | - J J Ríos-Martín
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - J L Rodríguez Peralto
- Departamento de Anatomía Patológica, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación I+12, Madrid, España
| | - E Rozas Muñoz
- Departamento de Dermatología, Hospital de San Pablo, Coquimbo, Chile
| | - O Sanmartín
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - C Santonja
- Servicio de Anatomía Patológica, Fundación Jiménez Díaz, Madrid, España
| | - A Santos-Briz
- Servicio de Anatomía Patológica, Hospital Universitario de Salamanca, Salamanca, España
| | - C Saus
- Servicio de Anatomía Patológica. Hospital Universitario Son Espases, Palma de Mallorca, España
| | - J M Suárez Peñaranda
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, España
| | - V Velasco Benito
- Servicio de Anatomía Patológica, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España
| | - M J Beato Merino
- Servicio de Anatomía Patológica, Hospital Universitario La Paz, Madrid, España
| | - A Fernandez-Flores
- Servicio de Anatomía Patológica, Hospital Universitario El Bierzo, Ponferrada, León, España; Servicio de Anatomía Patológica, Hospital de la Reina, Ponferrada, León, España; Unidad de Investigación, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidad de A Coruña, A Coruña, España.
| |
Collapse
|
21
|
Garcia LC, Vale ECSD, Ferrari MDL, Faria LDDC. Gummatous cutaneous tuberculosis associated with the use of infliximab for Crohn's disease. An Bras Dermatol 2021; 96:228-230. [PMID: 33593700 PMCID: PMC8007547 DOI: 10.1016/j.abd.2020.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 07/14/2020] [Indexed: 01/25/2023] Open
Abstract
As the treatment of infectious and parasitic diseases improved, the prevalence of these conditions declined. However, with the expansion of the use of immunobiologicals, opportunistic infections have emerged, especially under atypical presentations. The present study reports the case of a patient treated with infliximab for Crohn's disease, who presented diarrhea, weight loss, abdominal pain, fever, and subcutaneous erythematous nodules that evolved with spontaneous fluctuation and ulceration. With the finding of alcohol-resistant bacilli and Mycobacterium tuberculosis DNA in a cutaneous fragment, through polymerase chain reaction, the diagnosis of gummatous tuberculosis was confirmed, probably secondary to hematogenous dissemination from an intestinal focus.
Collapse
Affiliation(s)
- Lucas Campos Garcia
- Dermatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | | | - Maria de Lourdes Ferrari
- Department of Gastroenterology, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | |
Collapse
|
22
|
Soto-Febres F, Ballena-López J, Alva D, Riboty A, León R, Chang J, Pérez-Lazo G, Hidalgo J. Cutaneous inoculation tuberculosis in a healthcare worker: Case report and literature review. IDCases 2020; 20:e00788. [PMID: 32426232 PMCID: PMC7225731 DOI: 10.1016/j.idcr.2020.e00788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 11/21/2022] Open
Abstract
In all health care settings, particularly those in developing countries, healthcare workers have a high risk for exposure to tuberculosis. Tuberculosis can involve any organ, including the skin. Cutaneous tuberculosis is uncommon and may be secondary to an exogenous inoculation. We report the case of a surgical resident at a tertiary care hospital in Lima, Peru who developed cutaneous inoculation tuberculosis after sustaining a needlestick injury while performing a diagnostic cervical lymph node aspiration from a patient with HIV infection and tuberculous cervical lymphadenopathy.
Collapse
Affiliation(s)
- F Soto-Febres
- Infectious Diseases Unit, Guillermo Almenara Irigoyen National Hospital, EsSalud. Lima - Peru
| | - J Ballena-López
- Infectious Diseases Unit, Guillermo Almenara Irigoyen National Hospital, EsSalud. Lima - Peru
| | - D Alva
- Head, Neck and Maxillofacial Surgery Service, Guillermo Almenara Irigoyen National Hospital, EsSalud. Lima - Peru
| | - A Riboty
- Environmental and Occupational Health Unit, Guillermo Almenara Irigoyen National Hospital, EsSalud. Lima - Peru
| | - R León
- Pathological and Surgical Anatomy Service, Guillermo Almenara Irigoyen National Hospital, EsSalud. Lima - Peru
| | - J Chang
- Pathological and Surgical Anatomy Service, Guillermo Almenara Irigoyen National Hospital, EsSalud. Lima - Peru
| | - G Pérez-Lazo
- Infectious Diseases Unit, Guillermo Almenara Irigoyen National Hospital, EsSalud. Lima - Peru
| | - J Hidalgo
- Infectious Diseases Unit, Guillermo Almenara Irigoyen National Hospital, EsSalud. Lima - Peru
| |
Collapse
|
23
|
da Silva Sousa AC, Sousa M, Tente D, Menezes N, Baptista A, Guedes R. Ungual Tuberculosis: A Unique Clinical Case. Skin Appendage Disord 2019; 5:386-389. [PMID: 31799269 DOI: 10.1159/000501698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/23/2019] [Indexed: 11/19/2022] Open
Abstract
Cutaneous manifestations of tuberculosis (TB) are rare, particularly from an exogenous source. Involvement of the nail apparatus is extremely rare and has only previously been reported as a secondary involvement. We report the case of a 76-year-old female patient referred to our department with onychodystrophy with purulent drainage of the first left finger, which had developed during the preceding year. She had no previous traumatic history and had received treatment with multiple cycles of oral antibiotics and antimycotics, with no clinical improvement. Physical examination showed paronychia and onychodystrophy of the entire nail plate. Biopsy evaluation revealed epithelioid granulomas with central foci of necrosis, and laboratory cultures were positive for Mycobacterium tuberculosiscomplex. Chest computed tomography excluded primary pulmonary TB. X-ray of the left hand revealed the presence of dactylitis on the distal phalanx. Based on these findings, the patient was treated with rifampicin, isoniazid, pyrazinamide, and ethambutol for 2 months and with rifampicin and isoniazid for 7 months, resulting in complete resolution of the lesions. Cutaneous TB is a diagnostic challenge, particularly in rare cases such as involvement of the nail apparatus. It should be considered as a diagnostic hypothesis in cases of painless paronychia with refractory purulent drainage and associated onychodystrophy.
Collapse
Affiliation(s)
| | - Manuel Sousa
- Pneumology Department of Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - David Tente
- Pathology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Nuno Menezes
- Dermatology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Armando Baptista
- Dermatology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Rita Guedes
- Dermatology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| |
Collapse
|
24
|
Fernandez-Nieto D, de Perosanz-Lobo D, Ortega-Quijano D, Jimenez-Cauhe J, Fernandez-Gonzalez P, Bea-Ardebol S. Tuberculous chancre in a foot leading to a disseminated tuberculosis infection. Ital J Dermatol Venerol 2019; 156:89-91. [PMID: 31760728 DOI: 10.23736/s2784-8671.19.06460-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | - Juan Jimenez-Cauhe
- Department of Dermatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Sonia Bea-Ardebol
- Department of Dermatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| |
Collapse
|
25
|
Rodríguez-Zúñiga MJM, Heath MS, Gontijo JRV, Ortega-Loayza AG. Pyoderma gangrenosum: a review with special emphasis on Latin America literature. An Bras Dermatol 2019; 94:729-743. [PMID: 31789268 PMCID: PMC6939079 DOI: 10.1016/j.abd.2019.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/14/2019] [Indexed: 01/01/2023] Open
Abstract
Pyoderma gangrenosum is a neutrophilic dermatosis characterized by chronic ulcers due to an abnormal immune response. Despite the existence of diagnostic criteria, there is no gold standard for diagnosis or treatment. In Latin America, recognizing and treating pyoderma gangrenosum is even more challenging since skin and soft tissue bacterial and non-bacterial infections are common mimickers. Therefore, this review aims to characterize reported cases of pyoderma gangrenosum in this region in order to assist in the assessment and management of this condition. Brazil, Mexico, Argentina, and Chile are the countries in Latin America that have reported the largest cohort of patients with this disease. The most frequent clinical presentation is the ulcerative form and the most frequently associated conditions are inflammatory bowel diseases, inflammatory arthropaties, and hematologic malignancies. The most common treatment modalities include systemic corticosteroids and cyclosporine. Other reported treatments are methotrexate, dapsone, and cyclophosphamide. Finally, the use of biological therapy is still limited in this region.
Collapse
Affiliation(s)
| | - Michael S Heath
- Oregon Health and Sciences University, Portland, United States
| | - João Renato Vianna Gontijo
- Adult Health Postgraduate Program, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Sciences University, Portland, OR, United States.
| |
Collapse
|
26
|
Coelho ID, Romãozinho C, Teixeira AC, Rodrigues L, Ferreira E, Santos L, Macário F, Alves R, Figueiredo A. A Rare Manifestation of Tuberculosis in a Renal Transplant Patient: A Case Report. Transplant Proc 2019; 51:1618-1620. [PMID: 31155204 DOI: 10.1016/j.transproceed.2019.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cutaneous lesions in the presence of fever in patients undergoing immunosuppressive therapy are a diagnostic challenge and may represent manifestations of multiple diseases, such as fungal infections, nocardiosis, lymphoproliferative diseases, zoonosis, and tuberculosis. The authors report a case of a 66-year-old white man with chronic kidney disease since 2014 (chronic pyelonephritis) who had a renal transplant in the previous 6 months. Induction therapy was performed with thymoglobulin, and his current immunosuppression scheme included tacrolimus, mycophenolate mofetil, and prednisolone. The patient had no history of pulmonary tuberculosis. The patient presented with 2 cutaneous lesions, localized on the back and abdomen, that appeared to be firm, painful, subcutaneous, erythematous nodules with an approximately 5 cm diameter overlying an infected focus and purulent material inside. The patient also had a fever and fatigue. Blood analysis showed pancytopenia with an elevation of inflammatory markers and graft dysfunction. Tissue cultures and skin biopsy with histological analysis were performed. Histopathology of the lesion showed a nonspecific inflammatory infiltrate without granulomas, and acid-fast bacillus staining was negative. Nevertheless, serum QuantiFERON testing was positive. But polymerase chain reaction finally confirmed the presence of Mycobacterium tuberculosis, which confirmed the diagnosis of cutaneous tuberculosis. A chest computed tomography scan showed a lung pattern of miliary tuberculosis. The patient was treated with multidrug tuberculosis therapy, resulting in lesion clearance after 3 weeks. Tuberculosis is a serious infection, especially in high-risk patients, such as those in an immunocompromised state. The incidence of cutaneous tuberculosis is rare, but it should be considered in patients presenting with atypical skin lesions suggestive of an underlying infectious etiology.
Collapse
Affiliation(s)
- I D Coelho
- Nephrology Department, Amato Lusitano Hospital, Castelo Branco, Portugal.
| | - C Romãozinho
- Nephrology Department, Coimbra University Hospital Center, Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - A C Teixeira
- Nephrology Department, Coimbra University Hospital Center, Coimbra, Portugal
| | - L Rodrigues
- Nephrology Department, Coimbra University Hospital Center, Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - E Ferreira
- Nephrology Department, Coimbra University Hospital Center, Coimbra, Portugal
| | - L Santos
- Nephrology Department, Coimbra University Hospital Center, Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - F Macário
- Nephrology Department, Coimbra University Hospital Center, Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - R Alves
- Nephrology Department, Coimbra University Hospital Center, Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - A Figueiredo
- Urology and Kidney Transplantation Department, Coimbra University Hospital Center, Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| |
Collapse
|
27
|
de Mello RB, do Vale ECS, Baeta IGR. Scrofuloderma: a diagnostic challenge. An Bras Dermatol 2019; 94:102-104. [PMID: 30726475 PMCID: PMC6360976 DOI: 10.1590/abd1806-4841.20188560] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/13/2018] [Indexed: 11/29/2022] Open
Abstract
Cutaneous tuberculosis is a rare form of extrapulmonary tuberculosis, comprising 1-2% of cases. Caused by Mycobacterium tuberculosis or related strains, it presents a wide range of clinical manifestations, mimicking other chronic dermatoses and leading to delayed diagnosis. A case of scrofuloderma is reported, whose diagnosis and treatment were only made six years after onset of the disease.
Collapse
Affiliation(s)
- Renan Bernardes de Mello
- Dermatology Service, Hospital das Clínicas, Universidade
Federal de Minas Gerais, Belo Horizonte (MG), Brazil
| | | | | |
Collapse
|
28
|
Zaslavskij DV, Egorova YS, Chuprov IN, Olovyanishnikov IO, Gurkovskaya YY, Sydikov AA, Chuzhov AL, Ovchinnikova YE, Dovgalyuk IF, Starshinova AA. DISSEMINATED CUTANEOUS TUBERCULOSIS. VESTNIK DERMATOLOGII I VENEROLOGII 2018. [DOI: 10.25208/0042-4609-2018-94-2-69-77] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Cutaneous tuberculosis is a clinically and morphologically heterogeneous group of skin diseases directly or indirectly caused by mycobacteria of the tuberculosis complex, occupying the 5th place among all localizations of extra-pulmonary tuberculosis. Manifestations of cutaneous tuberculosis are extremely diverse and depend on the immune status and ways of penetration of mycobacteria into the skin. Skin involvement can occur as a result of exogenous inoculation, contiguous spread from an adjacent focus, or hematogenous spread from other foci. Family cases of disseminated cutaneous tuberculosis are described. A combination of several clinical forms of cutaneous tuberculosis — scrofuloderma, tuberculosis cutis lichenoides (moniliformis scrophulosorum) and lupus — are observed in a 5 year old child with a family history of tuberculosis. The issues of pathogenesis and advanced methods of diagnosis of cutaneous tuberculosis are also discussed.
Collapse
|
29
|
Tirado-Sánchez A, Bonifaz A. Cutaneous Tuberculosis: a Review of the Current Literature. CURRENT TROPICAL MEDICINE REPORTS 2018. [DOI: 10.1007/s40475-018-0140-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
30
|
Hao D, Olugbodi A, Udechukwu N, Donato AA. Trauma-induced adiposis dolorosa (Dercum's disease). BMJ Case Rep 2018; 2018:bcr-2017-223869. [PMID: 29592996 DOI: 10.1136/bcr-2017-223869] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
We present a case of a 39-year-old man who presented with chronic bilateral upper extremity pain associated with innumerable angiomyolipomas that developed 5 years after a motor vehicle accident involving his upper extremities. Our case notes the rare nature of painful adipose tissue deposits and the diagnostic challenges.
Collapse
Affiliation(s)
- David Hao
- Internal Medicine, Reading Hospital and Medical Center, West Reading, Pennsylvania, USA
| | | | - Nneka Udechukwu
- Internal Medicine, Reading Hospital and Medical Center, West Reading, Pennsylvania, USA
| | - Anthony A Donato
- Internal Medicine, Reading Hospital and Medical Center, West Reading, Pennsylvania, USA
| |
Collapse
|
31
|
Zhang J, Fan Y, Wang P, Chen Q, Wang G, Xu A, Chen L, Hu R, Chen W, Song Z, Hao F. Cutaneous tuberculosis in China - A multicentre retrospective study of cases diagnosed between 1957 and 2013. J Eur Acad Dermatol Venereol 2018; 32:632-638. [PMID: 29476577 DOI: 10.1111/jdv.14851] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 01/10/2018] [Indexed: 11/28/2022]
Affiliation(s)
- J. Zhang
- Department of Dermatology and Venereology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - Y.K. Fan
- Department of Dermatology and Venereology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - P. Wang
- Department of Dermatology and Venereology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - Q.Q. Chen
- Department of Dermatology and Venereology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - G. Wang
- Department of Dermatology and Venereology; Xijing Hospital; Forth Military Medical University; Xi'an China
| | - A.E. Xu
- Department of Dermatology and Venereology; Third People's Hospital of Hangzhou; Hangzhou China
| | - L.Q. Chen
- Department of Dermatology and Venereology; First People's Hospital of Wuhan; Wuhan China
| | - R. Hu
- Department of Dermatology and Venereology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - W. Chen
- IZZ Immunologie-Zentrum Zürich; Zurich Switzerland
- Department of Dermatology and Allergy; Technische Universität München; Munich Germany
| | - Z.Q. Song
- Department of Dermatology and Venereology; Southwest Hospital; Third Military Medical University; Chongqing China
| | - F. Hao
- Department of Dermatology and Venereology; Southwest Hospital; Third Military Medical University; Chongqing China
| |
Collapse
|
32
|
Affiliation(s)
- Catarina Pereira
- Hospital Pediátrico Centro Hospitalar e Universitário de Coimbra Coimbra, Portugal
| | - Mafalda Cascais
- Hospital Pediátrico Centro Hospitalar e Universitário de Coimbra Coimbra, Portugal
| | - Miguel Félix
- Hospital Pediátrico Centro Hospitalar e Universitário de Coimbra Coimbra, Portugal
| | - Manuel Salgado
- Hospital Pediátrico Centro Hospitalar e Universitário de Coimbra Coimbra, Portugal
| |
Collapse
|